Innumerable Indians are addicted to nicotine (one of the most habit-forming substances known to man) in various forms.  Some smoke, others sniff or chew it. Many live under the myth that chewing gutka or smokeless tobacco is less harmful than smoking. Most not aware that gutka is literally ‘a pinch of poison’ and an ingredient for severe ailments and slow death. Specialists especially oncologists say consumption of gutka is more harmful than any other form of tobacco.

WHAT IS GUTKA?

Gutka is a smokeless tobacco that is not burned when chewed. Gutka is consumed by placing between gum and cheeks for gentle chewing and sucking. In India, it’s a familiar sight to come across people who chew tobacco and spit out the red coloured juice. While this juice is desecrating our walls, monuments, and streets across the country, gutka is sucking the lives out of people.

Gutka, also known as mawa or Colorful, is a combination of crushed arecanut, slaked lime, paraffin and katechu, sweet or savoury flavorings along with tobacco.  This mixture, which is promoted and sold as a mouth freshener, has about 4,000 chemicals of which at least 40 are carcinogenic (potential to cause cancer) compounds. 

Remember, use of chewing tobacco is not restricted to rural India. Colourful packaging, stylized advertising (both direct and surrogate) and endorsements by mainstream cinema stars including one from Hollywood (!) have pushed many towards it. And these include college students to well-educated office going youth and adult.

HEALTH HAZARDS OF SMOKELESS TOBACCO

Smokeless tobacco is more hazardous than smoking because the chewed mixture directly enters the system through the oral cavity. Whereas with smoking, only 20 percent of the harmful chemicals reach the lungs and 80 percent is exhaled.

Cancerous chemicals cause a non-healing ulcer in the mouth and oral cavity as well food pipe and voice box. Some element in the betel nut causes hardening of the fissure in the mouth. When untreated can lead to cancer of the mouth or oral cavity.

According to Global Burden of Disease Study (2010) and Global Adult Tobacco Survey, in 2010 alone smokeless tobacco resulted in more than 62,000 deaths due to cancers of the mouth and food pipe and accounted for more than 200,000 deaths from heart disease. 

According to BBC report, India is the oral cancer capital of the world. Data suggests India continues to have the highest prevalence of oral cancers globally with 75,000 to 80,000 new cases of such cancers reported every year. Most of this type of cancer can be attributed to the use of chewing tobacco considering more Indians chew tobacco than smoke it.

Also, it leads to other conditions like hypertension, heart disease, and stroke.  Consumption of gutka during pregnancy can result in low birth weight babies. Other effects include loss of appetite, unusual sleep patterns and loss of concentration.

Despite the astounding public health impacts caused by this deadly product and a Supreme Court directive (2016) to completely stop the sale of gutka, companies still sell pan masala and tobacco in separate pouches to circumvent the gutkha ban. The crackdown has been unsuccessful, and some state like Maharashtra has also revoked gutka ban this year! 

THE SOLUTION

A complete ban on gutka and its allied product like pan masala is the only way to curb this deadly habit. Until the government and legal authorities become unified and mindful about this significant health problem; it is imperative to think before you chew (your life away).

No addict wants to live the life of an addict. And it’s quite disturbing to be afflicted by any habit especially if it’s a deadly one. Nicotine dependency is a difficult habit to overcome, but with help, it’s possible for a fresh start.

PRACTICAL TIPS TO INITIATE CHANGE

1. Write down the reasons: Quitting tobacco can be tricky, and during pressing times it is likely that one will forget or ignore the reason they initiated change. So, jot down the reason for quitting including ill effects of tobacco on your teeth, breath, mouth, and health. Remember, you won’t have to repeatedly excuse yourself from a social gathering to chew tobacco or spit the accumulated red paste! Do write about the positive impact on health and pocket (financially), and how good it would be the lead the change in your group of smokers/tobacco chewers.
2. To cut down or quit at once: For some reducing the amount of gutka per day may be a way to test their commitment and motivation for change. But for most others, it’s best to stop altogether alongside professional help and nicotine substitute treatment plan. Quitting at once can bring discomforting nicotine withdrawals that will ease with nicotine substitutes like nicotine chewing gum or patches, but will also convey feelings of wellbeing and renewed confidence.
3. The process:

• Write a gutka diary to identify patterns of chewing. If you are planning to reduce intake, then try and cut down on non-essential chewing first before venturing into critical ones (for example after meals).
• Choose a day to quit and go for a ceremonial burial /clearance of gutka packets and all its paraphernalia.
• Making a formal announcement of your intentions to friends and family will desirably force you to stick to it.
• Designate an anchor (ideally spouse or partner) to encourage, support and push you to achieve your aims.
• Delay and distract your urges to chew with juices, healthy snack, mint, etc. Smoker and gutka chewers often have difficulties in discerning urge to smoke from hunger. So, consuming a small meal/snack can remedy those rising craves.
• Keep away from people who are into tobacco continuously. Avoid the company of gutka gang at least in the initial days. Once you have better control over the urges, then you may attempt exposing yourself to higher risk situation for further desensitisation.
• Celebrate your quit day, weekly and monthly, with reward/gift from the money you have saved. Announce your success so far, in person and on social media for positive re-enforcement.
• Don’t worry about slips ups, instead focus on achievements. So, fight ‘one crave at a time’ and work on ‘one day at a time’. Build on successes of the previous day and learning from lack of it. It is well established that the craving, when unattended, become less intense and fizzles out over time.   
• Take up exercise to reap the benefit of improved health and appetite.
• Importantly, consider nicotine substitutes like chewing gum or 24-hour Nicotine patches. Be informed that these substitutes are gradually reduced over time and stopped, so ideally taken under professional guidance and support from a de-addiction specialist. You do not want to substitute one habit for another. Research suggests that majority who try to quit without the specialist advice and replacement therapy, relapse soon afterward.
• Finally, there is medication to reduce craving and associated anxiety. These require a formal script from a practicing physician or a psychiatrist.

Final points to note

Quitting tobacco may be the best decision of your life. If you don’t succeed at first, then revisit, review and rework the plan.  Importantly, try again and do something different each time including professional support. Remember, lack of success and relapse to chewing can never be the end of the road. Instead, it must be seen as a sign of progress on the cycle of change and towards better health.  Never give up or quit on quitting! 

On the eve of WHO’s World No Tobacco Day (31 May 2018), It is worth being reminded that not just cigarettes, tobacco is harmful in many forms. This article was previously published in partial form in Business Economics Oct 2017 Issues.

Do Read, Comment and Share this anti-tobacco MindBlog series to raise awareness of the devastating consequence of tobacco in all its forms.

Other Recommended Reading: WHO’s Tobacco Free Initiative (TFI) on World No Tobacco Day.